Background: Neutrophil lymphocyte ratio (NLR) reflects the balance between neutrophils and lymphocytes. It may represents a prognostic predictor for the acute ischemic stroke severity. Objective: This study aimed to assess the relationship of NLR with the brain imaging (Computed Tomography (CT) and or Magnetic Resonance Imaging (MRI)) and carotid duplex findings in acute ischemic stroke patients. Methods: This study was conducted on sixty acute ischemic stroke patients (26 males, 34 females), their ages ranged from 45 to 95 years. Patients were subjected to detailed medical, neurology history taking, laboratory assessment including white blood cells (WBCs) count, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC). NLR was calculated by dividing ANL by ALC, imaging investigation including CT and or MRI and carotid duplex ultrasonography. Results: There was a statistical significant association between NLR and the size of infarction among the studied patients, however there was no statistical significant association between NLR and findings of carotid duplex in our study. Conclusion: The higher the neutrophil lymphocyte ratio, the larger the size of infarction is expected.